A Canadian journal has issued corrections on 138 case reports it published over the last 25 years to add a disclaimer: The cases described are fictional.
Paediatrics & Child Health, the journal of the Canadian Paediatric Society, has published the cases since 2000 in articles for a series for its Canadian Paediatric Surveillance Program. The articles usually start with a case description followed by “learning points” that include statistics, clinical observations and data from CPSP. The peer-reviewed articles don’t state anywhere the cases described are fictional.
The corrections come following a January article in New Yorker magazine that mentioned one of the reports — “Baby boy blue,” a case published in 2010 describing an infant who showed signs of opioid exposure via breast milk while his mother was taking acetaminophen with codeine. The New Yorker article made public an admission by one of the coauthors that the case was made up.
“Based on the New Yorker article, we made the decision to add a correction notice to all 138 publications drawing attention to CPSP studies and surveys to clarify that the cases are fictional,” Joan Robinson, editor-in-chief of Paediatrics & Child Health, told Retraction Watch. “From now on, the body of the case report will specifically state that the case is fictional.”
The move came as a surprise to David Juurlink, professor of medicine and pediatrics at the University of Toronto, who has spent over a decade looking into the claim that infants can receive a meaningful or even lethal dose of opioids via breast milk when their mothers take acetaminophen with codeine. The first such case, published in the Lancet in 2006 by pharmacologist Gideon Koren, was the centerpiece of the New Yorker article. (The Lancet case report now bears an expression of concern.) Koren used that case to claim for years that codeine, which gets metabolized to morphine in the body, can pose a lethal risk to breastfeeding infants.
Follow-up work by Juurlink and others has found the doses claimed in the Lancet report — as well as in two other articles, both now retracted, Koren and colleagues wrote about the case — to be pharmacologically unlikely. As the New Yorker reported, a review of the autopsy data and other evidence points to the baby having been given the pain medication directly rather than having been exposed to the drug through breast milk.
The Baby boy blue case is “the only such case study, aside from the Lancet case report and the two now-retracted descriptions of the same case in Canadian Family Physician and Canadian Pharmacists Journal,” Juurlink said. “It is the most compelling published description of neonatal opioid toxicity from breastfeeding. And it is wrong.”
Juurlink said he doesn’t think a correction is sufficient for this case in particular. “The paper should obviously be retracted,” he told us. “It’s a fictional case portrayed as real and its scientific underpinnings have collapsed, yet it perpetuates them.”
While the instructions for authors for Paediatrics & Child Health has at times indicated the case reports are fictional, that disclosure has never appeared on the journal articles themselves.
“Readers of primary source peer reviewed medical scientific journals have an absolute right to believe that the article being read is as accurate as possible, original, and factual, unless clearly specified otherwise,” said former JAMA editor George Lundberg. “‘Alternative facts,’ as popularized by Kellyanne Conway, have no place in a medical or scientific journal.”
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